Citation Nr: 18146332 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-39 994 DATE: October 31, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and Generalized anxiety disorder (GAD) is granted. FINDING OF FACT The preponderance of the evidence of record reflects that the Veteran’s acquired psychiatric disorder, to include PTSD and GAD, is related to her in-service military sexual trauma (MST). CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and GAD have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the US Army and the US Navy from April 1981 to September 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and GAD is granted Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). To establish service connection for the claimed disorder, there must be evidence of (1) a current claimed disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A disorder diagnosed after discharge may be service connected if all the evidence establishes that it was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The requirements for establishing PTSD under 38 C.F.R. § 3.304 (f) are separate from those for establishing a general service connection claim. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Establishing service connection for PTSD requires (1) medical evidence diagnosing PTSD under 38 C.F.R. § 4.125 (a); (2) a link, established by medical evidence, between a veteran’s present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f) (2017); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). If PTSD was diagnosed by a medical professional, VA must assume that the diagnosis meets the DSM criteria relating to the adequacy of the symptomatology and sufficiency of the stressor. Cohen, 10 Vet. App. at 153. If a PTSD claim is based on an in-service personal assault, evidence from sources other than the Veteran’s service records may corroborate the Veteran’s account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. 38 C.F.R. § 3.304 (f)(5). Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304 (f)(5). In cases involving an allegation that PTSD is connected to military sexual assault, the Federal Circuit has held that “the absence of a service record documenting an unreported sexual assault is not pertinent evidence that the sexual assault did not occur.” AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013). The Veteran contends that while serving aboard her ship, she was sexually assaulted by a Master-at-Arms (MA), who was a Petty Officer. She did not report it in the Navy’s chain of commands, for fear of repercussion. The Board notes that per the Merriam-Webster Dictionary, a master-at-arms is a petty officer (in the Navy) charged with maintaining discipline aboard the ship. Per VA treatment records, the Veteran has diagnoses of PTSD, anxiety disorder, NOS and GAD. Therefore, the Veteran has a current diagnosis of an acquired psychiatric disorder. The first element of service connection claim is met. The Veteran’s service treatment records (STRs) are silent for complaint or treatment for sexual assault. In June 1985, upon physical examination, “she did not want to remove her jacket because she gets cold easily.” The record also shows that in August 1985, the Veteran was admitted to Medical Hold for 30 days “for continued treatment.” The post-service VA treatment notes, dated in November 2003, indicate that the Veteran was seen for a MST consultation and received a diagnosis of PTSD. In April 2016, during a mental status examination, the VA psychiatrist indicated that his working diagnoses included PTSD secondary to MST and noted that the Veteran “was the victim of long-term, well-planned out, almost predatory sexual trauma and abuse ... and in many ways, punished for being the victim. She has the characteristic symptoms often found in this kind of PTSD. They also expressed themselves in aches, pains, nonrestorative sleep, difficulty with trust, many typical issues.” This record is highly probative evidence in favor of her claim. The Veteran, in support of her claim, has provided a statement from her friend, D. B. D., dated in June 2015. D. B. D. competently and credibly states that the Veteran in the summer of 1985, told her that while confined to the ship for extra duty, the MA sexually assaulted her. D. B. D. noted that the Veteran was “upset and noticeably agitated and afraid” when relaying the incident. Concerning the nexus, the Veteran was provided a VA PTSD Disability Benefits Questionnaire (DBQ) in July 2016. The medical examiner diagnosed GAD, which he opined “better explained her symptoms” because she did not meet the “full criteria for PTSD.” In his supplemental opinion of August 2016, he proffered a negative opinion as to the etiology of the Veteran’s GAD, as solely due to her reported in-service sexual assault. He noted that it would be mere speculation as to “what particular event lead to her GAD because the Veteran experienced several other stressors (neighbor being accused of rape and murder, daughter going to prison, medical concerns, past hospitalization to stress unit).” Therefore, the examiner concluded that the etiology of her GAD could not be accurately determined. However, the examiner stated that, “all of these stressors, along with her alleged in-service sexual assault, are attributed to her diagnosis of GAD.” The Board accords the supplemental opinion of the August 2016 VA examiner speculative and assigns little probative value to his negative nexus opinion. In August 2017, the Veteran provided a positive nexus medical opinion from J. M., Ph. D. Dr. J. M. concluded that the Veteran indeed has PTSD, and it resulted from her military sexual trauma. He rationalized that the lay and medical evidence of record, especially that of VA psychologist F. W., backs such a position. He noted his support for the conclusion reached by Dr. F. W. in an April 2016 VA mental status examination and reiterated Dr. F. W. findings of a working diagnosis of PTSD, secondary to MST. Further, he acknowledged that Dr. F. W. also noted that the “Veteran had the characteristic symptoms often found in this kind of PTSD, which expressed themselves in aches, pains, nonrestorative sleep, difficulty with trust, many typical issues.” The Board notes that this private medical opinion was provided with adequate rationale, and the facts discussed by the examiner accurately reflect the medical and lay evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Thus, the Board finds the August 2017 private opinion, coupled with the April 2016 VA psychology assessment of April 2016, most probative in a finding that the Veteran has PTSD and that there is a direct correlation between the Veteran’s current symptoms thereof, and her MST. (Continued on the next page)   Accordingly, the Veteran has reported a stressor that is related to her MST and provided a competent and credible statement from D. B. D, in support thereof. The Veteran has been diagnosed with PTSD by a VA psychologist, who also links her PTSD secondarily to her MST. Further, the Veteran has provided a private medical opinion that concurs with the April 2016 VA psychologist’s findings. As such, the Board herein finds that the Veteran has a current diagnosis of PTSD and it has been sufficiently linked to her MST stressor. In sum, when resolving the benefit of the doubt in favor of the Veteran, the Board finds that the statutory and regulatory criteria for entitlement to service connection for PTSD have been met. The claim is, therefore, granted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Stevens, Associate Counsel